Regional Health Information Organizations:

Where Are We Now?

April 19, 2005

Harris County Public Health Task Force

Information Technology Subcommittee

Status Report

April 28, 2005

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AgendaAgenda

Overview of IT subcommittee charter and membership

Results of clinician interviews

Regional Health Information Organizations (RHIO) overview

Go forward action plan

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CharterCharter

Provide recommendations to the Harris County Public Healthcare Council on how our Community can better use technology to improve public health care service delivery. The scope of this group would be to:

Develop an electronic network to support a more integrated flow of information between our communities emergency rooms and public / private clinics

Review technology offerings that may solve this problem and be used to build a community infrastructure

Determine the value proposition to the potential end users

Identify governance, funding, and operations models to support the effort

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MembershipMembership

David Bradshaw Memorial Hermann

Charles Bacarisse Harris County

Bill Burge HealthLink

Ron Cookston HCPH

Janet Donath Good Neighbor Healthcare Center

David Fenn Texas Children’s Hospital

Elena Marks City of Houston

Robert Murphy, MD Memorial Hermann

Kathleen Randall Greater Houston Partnership

Linda Ricca HealthLink

Beverly Shelton Memorial Hermann

Tom Shirley CHRISTUS St. Joseph Hospital

Manfred Sternberg Bluegate

Tim Tindle Harris County Hospital District

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From the Front LinesFrom the Front Lines

Providers Speak on the Need for

Regional Information Sharing

Robert Murphy, MD

Presentation to the Harris County Public Health Council

April 28, 2005

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• Growing number of uninsured

• ED overcrowding and diversion

• Rising costs of medical care; well-described “waste”

A system in crisis:

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Caregivers on the front-lines can speak to problems-and solutionsCaregivers on the front-lines can speak to problems-and solutions

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InterviewsInterviews

David Buck, M.D., President & CMO – Houston Healthcare for the Homeless Guy Clifton, M.D., Neurosurgeon, Memorial Hermann Stacie Cokinos, CFRE, San Jose Clinic Ron Cookston, Ed.D, Director – Gateway to Care Janet Donath, Executive Director - Good Neighbor Healthcare Clinic Karin Dunn, Navigation Supervisor, Gateway to Care Jeremy Finkelstein. M.D., Medical Director ER – Methodist Tom Flanagan, AVP Emergency Services, Memorial Hermann Thomas Granchi, M.D., Medical Director ER - Ben Taub Brent King, M.D., ER Chief – Hermann, University of Texas Carol Paret, VP Clinical Effectiveness, Memorial Hermann; Vice Chair, Gateway to

Care Frank Redmond, M.D., Medical Director ER - St. Luke’s John Riggs, M.D., Medical Director, Harris County Hospital District Miriam Serrano, Care Navigator, Good Neighbor Health Clinic Joan Shook, M.D., Medical Director ER - Texas Children’s Jorge Trujillo, M.D., Medical Director ER - St. Joseph’s

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1. Eligibility determination is costly to administer and a barrier to care1. Eligibility determination is costly to administer and a barrier to care

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2. Duplication of care is expensive, inefficient, and a risk for patients2. Duplication of care is expensive, inefficient, and a risk for patients

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Abnormal EKG—new or old?Abnormal EKG—new or old?

Even when testing is appropriate, without comparison ADMIT

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Many duplicate procedures have risksMany duplicate procedures have risks

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Cardiac catheterization may result in a serious complicationCardiac catheterization may result in a serious complication

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3. Barriers to information sharing cause poor coordination of care3. Barriers to information sharing cause poor coordination of care

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HIPAA and release of information rules have hindered accessHIPAA and release of information rules have hindered access

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“I shuffle way too

much paper…that is

time I would rather

be caring for patients”

--emergency physician

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“We can never get ER

records. We often ask

patients to drive to the clinic

just to sign paperwork.”

—clinic director

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“I had a patient with a red

leg and possibly a blood

clot. With follow-up, we

could have discharged her

home on medication but

instead we admitted her for

observation”

--ED physician

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Currently no access to clinic schedules after hoursCurrently no access to clinic schedules after hours

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“ ‘Go to the ER’ becomes the default—that is where the specialists are. I can’t blame them.”—ED physician“ ‘Go to the ER’ becomes the default—that is where the specialists are. I can’t blame them.”—ED physician

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4. Poorly managed chronic conditions are the most serious problem4. Poorly managed chronic conditions are the most serious problem

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“The cliché I see is that people

think that the ED is overrun with

inappropriate patients. I don’t see

that to be the case. These

[non-urgent] cases are easy.

5 minutes and they are out.”

--emergency physician

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“It’s not the non-urgent care that’s killing

us; it the serious complications of

chronic conditions.”

—emergency physician

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“Patients needing acute care (flu, sore throats, etc) are

not the issue; The issue is lack of disease management

for chronic conditions. The chronic conditions are more

of a drain on the ED system because patients continue

to present to ED due to lack of management of these

conditions”

—public health leader

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Patients with (seizure disorder, asthma, diabetes, high blood pressure) “unable” to get meds.Patients with (seizure disorder, asthma, diabetes, high blood pressure) “unable” to get meds.

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Is there a role for a “care facilitator” or care navigator”?Is there a role for a “care facilitator” or care navigator”?

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…CAN be achieved!

1.Better eligibility determination

2. Less duplication of expensive care

3. Improved coordination of care

4. Improved management of chronic conditions

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Information technology won’t solve all the problems….Information technology won’t solve all the problems….

…but the community solutions cannot be delivered without improved regional information sharing

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Providers are willing to work towards integrated solutions

Providers are willing to work towards integrated solutions

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Information ChallengesInformation Challenges

Identification of patients from multiple providers

Aggregation of patient specific clinical data

Notification system for important events

Data protection - security and confidentiality

Interoperability between existing systems

Value identification and quantification

Operations

Funding and governance

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Framework for Strategic ActionFramework for Strategic Action

Four goals, 12 strategies (http://www.hhs.gov/healthit/ ) Inform clinical practice Interconnect clinicians Personalize care Improve population health

Consolidates and coordinates many initiatives currently underway

Makes the case for “why now” to adopt HIT Avoid medical errors Improve use of resources Accelerate diffusion of knowledge Reduce variability of care Advance consumer role Strengthen privacy and data protection Promote public health and preparedness

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Current RHIO ActivityCurrent RHIO Activity

Over 140 RHIO efforts underway nationwide

Typically formed by providers, business coalitions, physicians, health plans, or government-related entities

42 states have at least one RHIO organized or planned

24 states have introduced and/or passed legislation supporting RHIOs or other e-health initiatives

Congress is considering bills in both Houses

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RHIO ExamplesRHIO Examples

Santa Barbara County Data Exchange – California

Massachusetts Technology Collaborative (MA-SHARE)

Rhode Island Health Improvement Initiative

Taconic Healthcare Community Information Network (Fishkill, NY)

Indiana Health Information Exchange

Maryland/DC e-Health Initiative

Delaware Health Information Network

MedVirginia – Richmond, VA

Maine Health Information Center

North Carolina Healthcare Information and Communications Alliance

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What’s WorkingWhat’s Working

Oversight provided by broad-based collaborative group representing the local healthcare market (e.g., providers, payers, hospital association, medical society, QIOs, DOH)

Collaborative group independent of a specific government agency or a single private entity

Focus is on community benefits, approach is patient-centric

Benefits are driving technology decisions, not the other way around

Business model based on subscriptions

Start up funding needed, sources are varied

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Common ChallengesCommon Challenges

Need for interoperability standardsMoney Start-up funds Sustainable funding model Payers will not pick up the full tab

Blueprint for a technology architecture Distributed versus centralized data structure Low technology user interface

Politics Finding a “Switzerland”

Competitive differences Lack of trust among parties Fear of lost advantage Pride of ownership

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Findings - GovernanceFindings - Governance

Most are creating a corporate structure

Some, but not many, are defined by state statute

Independent

LLC incorporation used frequently, some are pursuing 501(c)(3) status

Boards are broadly representative of the local healthcare market

Typically have working committees to establish policies (e.g., mission, governance, financing, technology, privacy & security, legal, communication & marketing)

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Go Forward Action PlanGo Forward Action Plan

Complete impact analysis to size the dollar value of solving this problem

Hire acting “Executive Director” from consulting firm to provide day to day leadership for the subcommittee

Establish 3 Work Groups: End user Technical Governance

Develop solution model (time, scope, and money)

Develop proposed governance models

Report back to the Council in 90 to 120 days from project kickoff